Skin problems

This chapter includes some of the common skin-related problems encountered in rehabilitation settings, including pressure ulcers, chronic venous ulcers, ischaemic ulcers, and osteomyelitis. A pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure, shear, and friction, either individually or in combination. The definition, features, and grades of pressure ulcers are discussed, followed by prevention and management strategies. The prevalence of leg ulcers ranges from 1 to 3 per 1000 population and can rise to 8.5% in those aged more than 65 years. The commonest causes of chronic ulcers are venous ulcers (60–70%), mixed ulcers (15–20%), arterial (10%), and systemic diseases and unusual causes (5%). The causes and management of leg ulcers are also discussed.

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Leg ulcer

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0035 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Diabetes Mellitus ◽

Time Course ◽

Pressure Ulcers ◽

Leg Ulcer ◽

The Other ◽

Venous Stasis ◽

Leg Ulcers ◽

Venous Ulcers ◽

Patients With Diabetes ◽

Neuropathic Ulcers

Venous ulcers account for by far the majority (about 70%), with mixed arterial/venous (about 10%) and arterial (about 10%) most of the remainder. Pressure ulcers have become increasingly common because of the increase in elderly, frail, and relatively immobile patients. The other causes are relatively rare with the exception of neuropathic ulcers in patients with diabetes mellitus. Note that many leg ulcers may have a multifactorial aetiology, i.e. they may involve more than one of the pathologies listed in Figure 29.1. The first thing is to ask about the ulcer. You should consider: • Is the ulcer painful? ■ Venous ulcers are caused by venous stasis in the leg and are thus less painful when elevated and drained of blood. However, only about 30% of venous ulcers are painful. ■ Arterial (atherosclerotic) ulcers are caused by ischaemia to the leg and are thus more painful when elevated and drained of blood. Patients often say the ulcers are painful enough to wake them up at night and that they obtain relief by lowering their leg over the side of the bed. ■ Neuropathic ulcers are caused by loss of sensation (which predisposes to constant trauma) and are thus not painful. ■ Pressure ulcers are caused by, as the name suggests, prolonged pressure on the affected site. They tend to be exquisitely tender but not necessarily painful if no pressure is being applied. • How long has the ulcer been there? ■ Venous ulcers are less painful and can therefore present late. They often have a long and recurring history. ■ Arterial ulcers tend to present relatively early because of pain. They often occur secondary to trivial trauma. ■ Neuropathic ulcers are associated with a loss of sensation and thus often present late. ■ Pressure ulcers can develop surprisingly rapidly (e.g. days in immobile patients if they are not turned regularly during their admission, even hours in patients who suffer a long lie following a fall), but can have a more indolent course depending on how much pressure is put on for how long. Thus the time course is not especially helpful. ■ A long history should arouse suspicion of a Marjolin ulcer, which only occurs in long-standing ulcers.

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Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH) in patients with chronic leg ulcers

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692007000300005 ◽

2007 ◽

Vol 15 (3) ◽

pp. 391-396 ◽

Cited By ~ 20

Author(s):

Vera Lúcia Conceição de Gouveia Santos ◽

Danielle Sellmer ◽

Marley Maciel Elias Massulo

Keyword(s):

Pressure Ulcer ◽

Ethical Issues ◽

Statistical Significance ◽

Leg Ulcers ◽

Kappa Index ◽

Rater Reliability ◽

Clinical Nurses ◽

Venous Ulcers ◽

The Right ◽

Chronic Leg Ulcers

This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH), in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00) obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (p<0.001). The PUSH instrument, in its Portuguese adapted version, showed to be reliable to the use in patients with chronic leg ulcers. Further studies should be conducted to evaluate its prospective performance.

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Prevention and management of pressure ulcers

Reviews in Clinical Gerontology ◽

10.1017/s0959259801011236 ◽

2001 ◽

Vol 11 (2) ◽

pp. 115-130 ◽

Cited By ~ 6

Author(s):

David R Thomas

Keyword(s):

Differential Diagnosis ◽

Blood Supply ◽

Pressure Ulcer ◽

Pressure Ulcers ◽

Venous Stasis ◽

Pathological Changes ◽

Bony Prominence ◽

Wound Type ◽

Chronic Ulcers ◽

Arterial Insufficiency

A pressure ulcer is the visible evidence of pathological changes in blood supply to the dermal and underlying tissues, usually due to compression of the tissue over a bony prominence. Pressure ulcers are one of several types of chronic ulcers of the skin, including venous stasis, diabetic ulcers, and arterial insufficiency ulcers. The differential diagnosis of pressure ulcers is imperative, since the management of each wound type differs substantially.

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Dermatology

Obstetric Medicine ◽

10.1093/med/9780198821540.003.0015 ◽

2020 ◽

pp. 509-520

Author(s):

Charlotte Frise ◽

Sally Collins

Keyword(s):

Erythema Nodosum ◽

Management Strategies ◽

Pemphigoid Gestationis ◽

Skin Changes ◽

Common Skin ◽

Changes In Pregnancy ◽

The Common ◽

In Pregnancy

This chapter covers the common skin changes in pregnancy, as well as atopic and polymorphic eruptions of pregnancy, pemphigoid gestationis, erythema nodosum, psoriasis, and more. For each condition, the background, symptoms, and potential effects on the fetus are described, as well as management strategies.

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The treatment of venous leg ulcers with a specifically designed compression stocking kit

Phlebologie ◽

10.1055/s-0037-1622230 ◽

2008 ◽

Vol 37 (04) ◽

pp. 191-197 ◽

Cited By ~ 13

Author(s):

V. Mattaliano ◽

G. Mosti ◽

V. Gasbarro ◽

M. Bucalossi ◽

W. Blättler ◽

...

Keyword(s):

Patient Characteristics ◽

Compression Stocking ◽

Leg Ulcers ◽

Compression Stockings ◽

Venous Leg Ulcers ◽

Venous Ulcers ◽

Time To Completion ◽

Validated Questionnaire ◽

First Choice ◽

Ankle Movement

SummaryTraditionally, venous leg ulcers are treated with firm nonelastic bandages. Medical compression stockings are not the first choice although comparative studies found them equally effective or superior to bandages. Patients, methods: We report on a multi-center randomized trial with 60 patients treated with either short stretch multi-layer bandages or a two-stocking system (Sigvaris® Ulcer X® kit). Three patients have been excluded because their ankle movement was restricted to the extent that they could not put on the stockings and 1 patient withdrew consent. Patient characteristics and ulcer features were evenly distributed. The proportion of ulcers healed within 4 months and the time to completion of healing were recorded. Subjective appraisal was assessed with a validated questionnaire. Results: Complete wound closure was achieved in 70.0% (21 of 30) with bandages and in 96.2% (25 of 26) with the ulcer X kit (p = 0.011). Ulcers with a diameter of up to about 4cm healed twice as rapidly, the larger ones as fast with the stocking kit as with bandages. The sum of problems encountered with bandages was significantly greater than that observed with the stocking kit (p < 0.0001). Pain at night and in the morning was absent with stockings but reported by 40% and 20% in the bandage group, respectively. The cardinal features associated with delayed or absent healing were ulcer size and pain. Conclusions: Common venous ulcers can readily be treated with the ulcer X compression kit provided the ankle movement allow its painless donning. Bandages, even when applied by the most experienced staff are less effective and cause more problems.

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Contributions to Management Strategies in the NE Atlantic Regarding the Life History and Population Structure of a Key Deep-Sea Fish (Mora moro)

Biology ◽

10.3390/biology10060522 ◽

2021 ◽

Vol 10 (6) ◽

pp. 522

Author(s):

Régis Santos ◽

Wendell Medeiros-Leal ◽

Osman Crespo ◽

Ana Novoa-Pabon ◽

Mário Pinho

Keyword(s):

Population Structure ◽

Life History ◽

Deep Sea ◽

Management Strategies ◽

Size Composition ◽

Large Size ◽

The Common ◽

Fishing Impacts ◽

Sea Fish

With the commercial fishery expansion to deeper waters, some vulnerable deep-sea species have been increasingly captured. To reduce the fishing impacts on these species, exploitation and management must be based on detailed and precise information about their biology. The common mora Mora moro has become the main deep-sea species caught by longliners in the Northeast Atlantic at depths between 600 and 1200 m. In the Azores, landings have more than doubled from the early 2000s to recent years. Despite its growing importance, its life history and population structure are poorly understood, and the current stock status has not been assessed. To better determine its distribution, biology, and long-term changes in abundance and size composition, this study analyzed a fishery-dependent and survey time series from the Azores. M. moro was found on mud and rock bottoms at depths below 300 m. A larger–deeper trend was observed, and females were larger and more abundant than males. The reproductive season took place from August to February. Abundance indices and mean sizes in the catch were marked by changes in fishing fleet operational behavior. M. moro is considered vulnerable to overfishing because it exhibits a long life span, a large size, slow growth, and a low natural mortality.

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Open-Label Study to Evaluate the Healing Rate and Safety of the Profore™ Extra Four-Layer Bandage System in Patients with Venous Leg Ulceration

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347540000400103 ◽

2000 ◽

Vol 4 (1) ◽

pp. 8-11 ◽

Cited By ~ 7

Author(s):

Aditya K. Gupta ◽

Joel De Koven ◽

Robert Lester ◽

Neil H. Shear ◽

Daniel N. Sauder

Keyword(s):

Healing Rate ◽

The Elderly ◽

Leg Ulcers ◽

Open Label ◽

Open Label Study ◽

Label Study ◽

Venous Leg Ulcers ◽

Initial Event ◽

Venous Ulcers ◽

High Compression

Background: Venous ulcers are increasing in prevalence, especially since these are observed more frequently in the elderly, and the number of individuals in this age group is becoming a larger portion of the population. Objective: To determine the healing rate and safety of the Profore™ Extra Four-Layer Bandage System in the management of venous leg ulcers. Methods: In an open-label study, patients aged 18 years or older with venous leg ulcers were treated with a high compression four-layer bandage system in which a hydrocellular dressing was placed in contact with the wound. The combination is designated the “Profore Extra Four-Layer Bandage System.” Follow-up visits took place weekly unless there was heavy exudation from the ulcer or if there was marked edema of the leg at the start of the study requiring reapplication of the bandage system. Results: Fifteen patients were entered into the study (men 8, women 7, mean age 66 years, mean duration of ulcers 1.3 years). Thirteen of the 15 patients completed the study, with two withdrawals. In one patient who withdrew, the ulcer became infected and required treatment with antibiotics. The other termination from the study occurred for reasons unrelated to treatment. The ulcer in this patient healed in 7 weeks. Ten of the 13 patients (77%) who completed the study, and 10 (67%) of 15, who had enrolled experienced complete (100%) healing. Healing of > 80% of the ulcers occurred in 11 of 13 patients (85%) who completed the study and in 12 (80%) of 15 enrolled patients. No patient experienced a study-related adverse event. One patient developed contact dermatitis and was later found to have stasis dermatitis. It is unclear whether the initial event was contact or stasis dermatitis. Conclusion: In this open-label study, a high compression system, using the Profore Extra Four-Layer Bandage with a hydrocellular dressing in contact with the wound, was found to be effective and safe for the treatment of venous leg ulcers.

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Treatment of venous leg ulcers with an ointment containing yarrow (Achillea millefolium) extract / Primena preparata sa ekstraktom hajdučke trave (Achillea millefolium) u lečenju venskih ulkusa potkolenice

Serbian Journal of Dermatology and Venerology ◽

10.2478/v10249-011-0009-9 ◽

2009 ◽

Vol 1 (3) ◽

pp. 101-106 ◽

Cited By ~ 1

Author(s):

Milan Matić ◽

Verica Đuran ◽

Marina Jovanović ◽

Zorica Gajinov ◽

Aleksandra Matić ◽

...

Keyword(s):

Wound Healing ◽

Saline Solution ◽

Achillea Millefolium ◽

Control Group ◽

Leg Ulcers ◽

Herbal Preparations ◽

Venous Leg Ulcers ◽

Accelerate Wound Healing ◽

Venous Ulcers ◽

Experimental Group

Abstract Traditional medicine credits yarrow (Achillea millefolium) with the ability to accelerate wound healing. The purpose of this research was to determine the effects of yarrow on the epithelization of the lower leg venous ulcers. The study included 39 patients with venous leg ulcers. They were divided into two groups: the first (experimental) group of patients were treated with an ointment containing 7.5% of yarrow extract. In the second (control) group, saline solution dressings were applied to ulcers, within the period of three weeks. In the experimental group, at the beginning of the therapy, the total surface of all the ulcers was 44736 mm2. After three weeks, the total surface of all the ulcers was 27000 mm2 (a decrease of 39.64%). In the control group, at the beginning of the therapy, the total surface of all the ulcers was 46116 mm2. At the end of the study (21 days) the total surface of all the ulcers was 39153 mm2 (a decrease of 15.1%). Herbal preparations are suitable for application in the therapy of venous ulcers, but their efficiency in wound healing is still to be investigated.

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Development of Resistance to Hymexazol Among Pythium Species in Cucumber Greenhouses in Oman

Plant Disease ◽

10.1094/pdis-11-16-1680-re ◽

2018 ◽

Vol 102 (1) ◽

pp. 202-208 ◽

Cited By ~ 8

Author(s):

Zainab M. Al-Balushi ◽

Hesham Agrama ◽

Issa H. Al-Mahmooli ◽

Sajeewa S. N. Maharachchikumbura ◽

Abdullah M. Al-Sadi

Keyword(s):

Ribosomal Rna ◽

Management Strategies ◽

Soil Samples ◽

Integrated Disease Management ◽

Pythium Species ◽

Internal Transcribed Spacer Region ◽

Development Of Resistance ◽

The Common ◽

Cucumber Roots ◽

Further Development

A study was conducted to characterize the common Pythium spp. in greenhouses in Oman and their level of resistance to hymexazol, a widely used fungicide in the country. Pythium isolates were obtained from soil samples, cocopeat bags, and cucumber roots collected from seven regions in the country. Identification of 80 Pythium isolates to the species level using sequences of the internal transcribed spacer region of the ribosomal RNA showed that they belong to four species: Pythium aphanidermatum (77 isolates), P. spinosum (1 isolate), P. myriotylum (1 isolate), and P. catenulatum (1 isolate). Investigating the aggressiveness of three Pythium spp. on cucumber showed that P. aphanidermatum, P. myriotylum, and P. spinosum are pathogenic. Phylogenetic analysis of P. aphanidermatum isolates showed that most of the isolates obtained from cocopeat clustered separately from isolates obtained from soil and roots. This may indicate a difference in the origin of the cocopeat isolates. Evaluating the resistance of 27 P. aphanidermatum isolates to hymexazol showed that most isolates were sensitive (0.9 to 31.2 mg liter−1) whereas one isolate was resistant (142.9 mg liter−1). This study is the first to report P. myriotylum and P. catenulatum in Oman. It is also the first to report the development of resistance to hymexazol among P. aphanidermatum populations from greenhouses. Growers should use integrated disease management strategies to avoid further development of resistance to hymexazol.

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